Published 12:40 pm, Monday, December 30, 2013

DEAR DOCTOR K: I’m often bothered by neck pain. What can I do to manage the pain when it strikes?

DEAR READER: Pain in the neck can be more than a pain in the neck. It can make things hard that are necessary or fun. It can interfere with a good night’s sleep. Like chronic pain anywhere in the body, neck pain can make a person grumpy, or worse.

There are many different causes of neck pain. Probably the most common is arthritis of the bones of the spine (the vertebrae) in the neck.

A few more serious conditions also can cause neck pain. Here are the symptoms that I ask patients about. I call them my “red flag” symptoms, because when they occur at the same time as neck pain, they could indicate a more serious condition: headache, shoulder pain, hip pain, sudden difficulty with vision, weakness in the arm or leg, loss of control of urine or bowel movement, recent injury to the neck, fever, chills, poor appetite and weight loss.

My goals in treating a patient’s neck pain are to relieve pain, restore function and reduce the risk of reinjury. Here are some pain-relieving strategies and exercises. You can use them to ease flare-ups and prevent recurrences:

• Rest. When you first experience neck pain — particularly if the pain is severe or sharp — you will need to rest your neck. Doctors no longer recommend total or prolonged bed rest, but resting your neck strategically can help reduce pain and prevent further damage.

First, avoid quick movements, positions that hurt and whatever activity caused the pain. Second, rest with your neck in a healthy position. Try this: Lie on your back, using a pillow under your knees to help your back relax. Support the curve of your neck from the base upward, using a rolled-up towel or a cervical pillow specially designed to support the neck.

Your doctor may recommend a cervical (neck) collar to help rest your neck muscles and protect damaged tissues from painful movements. Wear the collar only as necessary, removing it several times a day to exercise your neck. Using the collar continuously or for too long will limit your range of motion and may cause your neck muscles to weaken.

• Cold and heat. Cold numbs pain and reduces swelling. When the pain first starts, wrap an ice pack in a cloth and apply it to your neck for 15 to 20 minutes every hour. After about six hours, switch to a heat pack applied directly to the sore or tense areas of your neck, for about 15 minutes at a time. That’s a good way to reduce pain and stiffness and relieve muscle spasms.

• Physical therapy. A physical therapist can teach you a set of exercises tailored to your specific neck problem. These exercises will stretch tight areas and build strength. The therapist will also teach you proper body mechanics to heal your neck and reduce the risk of reinjury. I’ve put a selection of gentle exercises for neck pain on my website, AskDoctorK.com.

Dr. Komaroff is a physician and professor at Harvard Medical School. AskDoctorK.com